Individual
MR. JIMMY ALLEN WYATT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
350 N CLYDE MORRIS BLVD, DAYTONA BEACH, FL 32114-2733
(386) 238-3289
(386) 238-3296
Mailing address
1808 NEEDLE PALM DR, EDGEWATER, FL 32132-3322
(386) 424-0158
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA9103344
FL
Other
Enumeration date
09/29/2005
Last updated
04/19/2017
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